Welcome to the inaugural edition of Ohio Health Value Review
State budget a mixed bag for tobacco use reduction
The recently passed state budget provided mixed results for efforts to reduce tobacco use in Ohio, a key factor in the state’s low health value. Ohio ranks 46 out of 50 states and the District of Columbia on health value in HPIO’s 2017 Health Value Dashboard, a composite measure of population health outcomes and healthcare spending.
Gov. John Kasich’s original budget proposal called for an increase in the excise tax rate on cigarettes from $1.60 per pack to $2.25 per pack. The governor’s plan also called for an increase in the tax rate for tobacco products other than cigarettes from 17 percent to 69 percent of wholesale price and levied a 69 percent tax on sale or use of nicotine vapor products beginning in 2018. Those taxes were removed from the House-passed version of the bill and were left out of the Senate budget, so the state’s tobacco tax rates remains unchanged. In addition, the Senate added a 50-cent tax cap on premium cigars.
There is a strong body of evidence that increasing the unit price of tobacco products, including increased taxes on cigarettes, is one of the most effective strategies for reducing tobacco use. In fact, according to data from Campaign for Tobacco-Free Kids, all of the Midwestern states that had significant reductions in adult smoking from 2013 to 2015 — Illinois, Minnesota, Pennsylvania and Ohio — had state and/or local cigarette tax increases between 2012 and 2015.
Although the General Assembly declined to raise the tax rate on tobacco products, they did approve funding targeted at tobacco use prevention and cessation.
Kasich’s original budget plan called for $22.2 million over two years to be appropriated to the Department of Health for tobacco prevention and cessation programs. That figure was reduced to $11 million in the House version before being increased to $25 million in the final budget.
The prevention and cessation allocation funding in the budget is substantially more than what was allocated from 2009 to 2015, but is still much less than the historically high spending to combat tobacco use in the early 2000s (Ohio spent $54.8 million in combined state and federal dollars in 2005).
As HPIO staff members were preparing the 2017 Health Value Dashboard, they wanted to not only identify areas where Ohio does well and needs improvement, but also pinpoint what factors played the largest role in the state’s overall poor ranking.
Digging deeper into the numbers showed that tobacco use is one of the key factors contributing to Ohio’s poor performance. The state ranks in the bottom quartile for both adult smoking and secondhand smoke exposure for children. Analysis of Dashboard data found a strong correlation between a state’s adult smoking rate and its health value rank. In other words, states with higher health value rankings tend to have lower smoking rates (see figure below).
Tobacco use contributes to many of Ohio’s greatest health challenges, including cardiovascular disease, cancer and infant mortality. In addition, tobacco use is a cost driver for Medicaid and employers. Researchers estimate that 15 percent of U.S. Medicaid costs are attributable to cigarette smoking and a recent Indiana study found that per member per month (PMPM) Medicaid expenditures were 51.4 percent higher for smokers compared to non-smokers. Smoking also increases healthcare costs for employers.
Beyond increasing the cost of tobacco products, HPIO’s “State Policy Options to Reduce Tobacco Use and Secondhand Smoke Exposure” also identified evidence-based strategies such as media campaigns, access to cessation counseling and medication and quitline interventions as approaches that are effective at reducing tobacco use.
While the state’s investment in prevention and cessation funding will likely help to reduce tobacco use in Ohio, the legislature’s decision to not increase tobacco taxes is a missed opportunity to improve Ohio’s overall health value rank.
Health value graphic
Health value tools
Population health and healthcare spending
- Guide to Improving Health Value — HPIO resource page
- America’s Health Ranking: 2017 Senior Report
- Quality-Spending Interactive, June 2017 Update — Commonwealth Fund
- Health Expenditures by State of Residence, 1991-2014 — Centers for Medicare and Medicaid Services
Social and economic environment
- Intersections between Education and Health — HPIO resource page
- Connections between Education and Health — HPIO brief
- Connections between Education and Health No. 2: Health Services in Schools
— HPIO brief
- Wallethub 2017’s Best & Worst State Economies
- Is the American Dream Alive or Dead? It Depends on Where You Look
— Economic Innovation Group brief
Access to care
- State policy options in the American Health Care Act — HPIO brief
- Factors Affecting States’ Ability to Respond to Federal Medicaid Cuts and Caps: Which States Are Most At Risk? — Kaiser Family Foundation
- Ohio Medicaid resources — HPIO resource page
- Medicaid Expansion Impacts on Insurance Coverage and Access to Care
— Office of the Assistant Secretary for Planning and Evaluation
- Using National Data to Examine the Quality of Care in Ohio’s Skilled Nursing Facilities — Scripps Gerontology Center, Miami University
- Mirror, Mirror 2017: International Comparison Reflects Flaws and Opportunities for Better U.S. Health Care — Commonwealth Fund
Public health and prevention
- A Closer Look at Tobacco Use and Health Value — HPIO brief
- Healthy Communities Initiative Tool — Federal Reserve Banks and RWJF
- U.S. concentrated poverty in the wake of the Great Recession — Brookings Institution
- Urban Blight and Public Health — Urban Institute
- Lead Exposure Linked to School Problems and Crime — National Bureau of Economic Research report
- What is Health Equity? And What Difference Does a Definition Make? — Robert Wood Johnson Foundation
- Inequality in Life Expectancy Among U.S. Counties, 1980 to 2014 — A study published in JAMA Internal Medicine
- Roadmaps to Equity — resources from HPIO forum
State Health Improvement Plan (SHIP) priority topics
Mental health and addiction
- State Strategies to Measure and Incentivize Adolescent Depression Screening and Treatment in Medicaid — National Academy for State Health Policy brief
- Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health
- State of American Well-Being: The Face of Diabetes in the United States
— Gallup-Sharecare Well-Being Index
Maternal and infant health